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Elderly male patient with stomach cancer. Has feeding tube into alimentary…

- - - - source of nutrients
        
        fiber
        
        vitamins
        
        potassium
  - - - infection
        
        Gastritis
        
        gastric ulcers
        
        caused by helicobacter pylori
        
        long term use of NSAIDs
- - - - also target GI tract epithelium
        
        vomiting
        
        diarrhea
        
        nausea
  - - - drip continuously into intestines
- - - - store and concentrate bile
    - - Exocrine
        
        secrete pancreatic juice
        
        secretory cells
        
        produce zymogen granules containing proenzymes
        
        inactive digestive enzymes
        
        composition of pancreatic juice
        
        electrolytes
        
        primarily HCO3-
        
        digestive enzymes
        
        amylase
        
        for carbohydrates
        
        lipase
        
        for lipids
        
        protease
        
        for proteins
        
        1 more item...
        
        nuclease
        
        for nucleic acids
      - Endocrine
        
        pancreatic islets
        
        insulin
        
        glucagon
    - - largest gland in body
        
        produces bile
        
        bile salts
        
        cholesterol derivative
        
        fat emulsification and absorption
        
        bilirubin
        
        pigment formed from heme
        
        broken down to stercobilin
        
        brown color of feces
        
        cholesterol, triglycerides, phospholipids, electrolytes
    - - HCl
        
        pareital cells
      - gastrin
        
        enteroendocrine G cells
    - - hormonal controls
        
        secretin
        
        cholecytokinin
      - increased secretion
        
        enterohepatic circulation
        
        return large amount of bile salts
        
        release of secretin
        
        response to acidic chyme
        
        release of cholecytokinin
        
        response to fatty chyme
  - - - Palate
        
        Tongue
        
        Salivary Glands
        
        Teeth
        
        mastication
        
        classified by shape
        
        4 more items...
        
        chewing
        
        1 more item...
        
        saliva
        
        cleanses
        
        dissolves
        
        1 more item...
        
        largely water
        
        contains salivary amylase
        
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        Secretory Cells
        
        Serous
        
        watery secretion
        
        3 more items...
        
        Mucous
        
        produce mucus
        
        2 more items...
        
        forms bolus
        
        mixture of food and saliva
        
        interlacing bundles of skeletal muscle
        
        initiates swallowing
        
        aids in speech and swallowing
        
        Filiform Papillae
        
        gives tongue roughness
        
        no tastebuds
        
        whitish appearance
        
        Soft Palate
        
        swallowing
        
        closes nasopharynx
        
        Hard Palate
        
        mucosa sightly corrugated
        
        create friction against tongue
    - - Oropharynx
        
        Laryngopharynx
        
        stratified squamous epithelium
        
        mucus producing glands
        
        passage of food, fluid, air
        
        Esophagus
        
        flat muscular tube
        
        runs from laryngopharynx to stomach
        
        collapsed when not involved in food propulsion
        
        1 more item...
        
        Mucosa
        
        stratified squamous epithelium
        
        simple columnar at stomach
        
        Submucosa
        
        areolar CT
        
        esophageal glands
        
        1 more item...
        
        Muscularis
        
        skeletal superiorly
        
        mixed in middle
        
        1 more item...
        
        adventitia instead of serosa
        
        two skeletal muscle layers
        
        inner layer runs longitudinally
        
        outer pharyngeal constrictors
    - - temporary storage tank
        
        starts chemical breakdown of protein
        
        converts food bolus into chyme
        
        4 Regular Tunics
        
        muscularis and mucosa are modified
        
        muscularis
        
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        mucosa
        
        3 more items...
        
        Types of Gastric Gland Cells
      - 50 ml volume
        
        can expand to 4 L
      - mucosa
        
        folds form rugae
        
        allow distention
        
        mucosal barrier
        
        protects stomach from harsh conditions
        
        thick layer of bicarbonate rich mucus
        
        tight junctions
        
        prevent juice from seeping underneath
        
        damaged epithelial cells
        
        replaced by division of stem cells
        
        replaced every 3-6 days
    - - major organ for absorption and digestion
        
        3 subdivisions
        
        Jejunum
        
        Ileum
        
        Duodenum
        
        structural modification for absorprion
        
        Circular Folds
        
        permanent folds
        
        force chyme spirally through lumen
        
        allow more time for nutrient absorption
        
        Villi
        
        finger-like projections of mucosa
        
        core contains dense capillary bed & lymphatic capillary
        
        lacteal
        
        1 more item...
        
        Microvilli
        
        cytoplasmic extensions
        
        brush border
        
        contain brush border enzymes
        
        1 more item...
      - HISTOLOGY
        
        4 types of cells in villi and crypts
        
        Paneth Cells
        
        secrete antimicrobial agents
        
        defensins
        
        lysozyme
        
        Enterocytes
        
        make up bulk of epithelium
        
        in crypts
        
        produce intestinal juice
        
        1 more item...
        
        in villi
        
        absorb nutirents and electrolytes
        
        enteroendocrine cells
        
        source of enterogastrones
        
        cholecytokinin
        
        secretin
        
        Goblet Cells
        
        mucus-secreting cells
        
        Mucosa-Associated Lymphoid Tissue (MALT)
        
        protection
        
        Peyer's Patches
        
        aggregated lymphoid nodules
        
        Submucosa
        
        areolar tissue
        
        Duodenal Glands
        
        secrete alkaline mucus
        
        neutralize acidic chyme
        
        1 more item...
    - - SUBDIVISIONS
        
        Colon
        
        several regions
        
        Ascending, Transverse, Descending
        
        abdominal cavity
        
        travels up right side
        
        1 more item...
        
        Sigmoid Colon
        
        S-shaped
        
        travels through pelvis
        
        Rectum
        
        has 3 rectal valves
        
        prevent feces to be passed with gas
        
        Appendix
        
        masses of lymphoid tissue
        
        part of MALT of immune system
        
        bacterial storehouse
        
        capable of recolonizing gut when necessary
        
        twisted shape
        
        susceptible to blockage
        
        Anal Canal
        
        opens to body exterior
        
        anus
        
        2 sphincters
        
        internal
        
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        superficial venous plexus
        
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        external
        
        1 more item...
        
        Cecum
        
        first part
  - - - coordination of 22 muscle groups
        
        2 phases
        
        Buccal Phase
        
        voluntary contraction of tongue
        
        pushes bolus into oropharynx
        
        Pharyngeal-esophageal Phase
        
        involuntary phase
        
        controlled by swallow center in brain stem
        
        food enters pharynx
        
        1 more item...
        
        mechanism can be short-circuited
        
        talking or inhaling while swallowing
        
        food may enter respiratory pathway
        
        1 more item...
    - - Gastric Phase
        
        lasts 3-4 hours
        
        provides 2/3 of gastric juice release
        
        stimulated by
        
        Distension
        
        activates stretch receptors
        
        1 more item...
        
        Chemical Stimuli
        
        stimulation of enteroendocrine G Cells
        
        1 more item...
        
        more protein in the meal
        
        increased release of HCl and gastrin
        
        inhibited by
        
        excessive acidity
        
        low pH
        
        1 more item...
        
        emotional stress
        
        stress, fear
        
        1 more item...
      - Intestinal Phase
        
        stimulated by
        
        food entering small intestine
        
        brief release of intestinal gastrin
        
        inhibited by
        
        4 main factors in duodenum
        
        distention of duodenum
        
        presence of acidic, fatty, hypertonic chyme
        
        Enterogastrones
        
        inhibit gastric secretion
        
        cholecystokinin (CCK)
        
        secretin
        
        Enterogastric reflex
        
        inhibits acid secretion
        
        short reflexes
        
        long reflexes
      - Cephalic Phase
        
        triggered by
        
        taste
        
        sight
        
        aroma
        
        thought
        
        act via Vagus nerve to stimulate gastric glands
        
        inhibited by
        
        loss of appetite
        
        depression
    - - stomach response to filling
        
        stretches to accommodate incoming food
        
        receptive relaxation
        
        Gastric Contractile Activity
        
        peristaltic waves move toward pylorus
        
        enteric pacemaker cells
        
        linked by gap junctions
        
        1 more item...
        
        distension & gastrin
        
        increase force of conraction
        
        pyloric valve
        
        liquids and small particles
        
        Gastric Emptying
        
        duodenum
        
        prevent overfilling
        
        2 more items...
        
        stomach empties about every 4 hours
        
        increase in fatty chyme entering duodenum
        
        1 more item...
  - - - large polypeptides
        
        small polypeptides and peptides
        
        amino acid monomers
        
        dipeptides
        
        tripeptides
    - - triglyceride
        
        free fatty acids
        
        monoglycerides
    - - only monosaccharides can be absorbed
        
        glucose
        
        fructose
        
        galactose
      - breakdown begins in mouth
        
        salivary amylase
        
        disaccharides
        
        oligosaccharides
        
        further breakdown
        
        maltose
        
        sucrose
        
        lactose
    - - nucleotide monomers
        
        free nitrogenous bases
        
        pentose sugars
        
        phosphate ions